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Etoposide

    Brands

    DEA Class; Rx

    Common Brand Names; VePesid, Toposar, Etopophos, vp 16

    • Antineoplastics, Podophyllotoxin Derivatives

    Topoisomerase inhibitor that causes DNA strand breaks and cell cycle arrest
    IV formulations used as part of combination therapy for refractory testicular tumors and as first-line treatment for small-cell lung cancer (SCLC); oral formulation used as first-line treatment for SCLC in combination with other chemotherapeutic agents
    Black Box Warning for severe myelosuppression with risk of infection or bleeding

    Indicated for

    • Testicular Cancer
    • Small-Cell Lung Cancer

    Hypersensitivity to etoposide or teniposide

    • Leukopenia (60-91%)
    • Nausea and Vomiting (30-40%)
    • Thrombocytopenia (28-41%)
    • Alopecia (20-90%)
    • Anorexia (13%)
    • Diarrhea (13%)
    • Leukopenia (60-91%)
    • Anemia (≤33%)
    • Pancytopenia (7%)
    • Stomatitis (6%)
    • Hepatic toxicity (3%)
    • Type 1 hypersensitivity (2%)
    • Orthostatic hypotension (1-2%)
    • Peripheral neuropathy (1-2%)

    Therapy causes myelosuppression that results in thrombocytopenia and neutropenia; fatalinfections and bleeding have occurred; obtain complete blood counts prior to each cycle and more frequently as clinically indicated; withhold further treatment if platelet <50,000/mm³ or ANC <500/mm³

    Use caution in hepatic impairment

    Do NOT inject rapidly (may cause hypotension); infuse over at least 30-60 min

    Injection site reactions may occur during administration; monitor closely

    Avoid pregnancy

    May result in oligospermia, azoospermia, and permanent loss of fertility; sperm counts have been reported to return to normal levels in some men, and in some cases has occurred several years after end of therapy; may damage spermatozoa and testicular tissue, resulting in possible genetic fetal abnormalities; males with female sexual partners of reproductive potential should use condoms during therapy and for at least 4 months after final dose

    May cause infertility in females of reproductive potential and result in amenorrhea; premature menopause can occur; recovery of menses and ovulation is related to age at treatment; advise females of reproductive potential to use effective contraception during treatment for at least 6 months after final dose

    Occurrence of acute leukemia with or without a preleukemic phase reported in rare instances in patients treated with etoposide alone or in association with other neoplastic agents; risk of development of preleukemic or leukemic syndrome unclear

    Prescriber must consider benefits versus risk of therapy; if severe reactions occur, dose should be reduced or discontinued and appropriate corrective measures taken; reinstitution of therapy should be carried out with caution, and with adequate consideration of further need for drug and alertness as to possible recurrence of toxicity

    Patients with low serum albumin may be at increased risk for etoposide associated toxicities

    Based on animal data and its mechanism of action, etoposide can cause fetal harm when administered to a pregnant woman; etoposide, the active moiety of etoposide phosphate is teratogenic in mice and rats advise pregnant women of potential hazard to a fetus; advise women of childbearing potential to avoid becoming pregnant

    There is no information regarding presence of etoposide in human milk or its effects on breastfed infant milk production; because of potential for serious adverse reactions in nursing infants, advise women not to breastfeed during treatment with etoposide

    Adults

    IV: 200 mg/m2 per day.
    PO: 100 mg/m2 per day.

    Geriatric

    IV: 200 mg/m2 per day.
    PO: 100 mg/m2 per day.

    Adolescents

    IV: 200 mg/m2 per day.

    Children

    IV: 150 mg/m2 per day.

    Infants

    IV: 120 mg/m2 per day.

    Etoposide

    capsule

    • 50mg

    injectable solution

    • 20mg/mL

    powder for injection

    • 100mg